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What the Evolution of 1332 Waivers Tells Us about Their Innovative Potential
Journal article   Open access   Peer reviewed

What the Evolution of 1332 Waivers Tells Us about Their Innovative Potential

Phillip M. Singer, Daniel Skinner and Brad Wright
Journal of health politics, policy and law, Vol.49(2), pp.269-288
04/01/2024
DOI: 10.1215/03616878-10989687
url
https://doi.org/10.1215/03616878-10989687View
Published (Version of record) Open Access

Abstract

Abstract Section 1332 of the Affordable Care Act (ACA) provides states unprecedented flexibility to alter federal health policy. We analyze state waiver activity from 2019 to 2023, applying a comparative approach to understand waivers proposed by Georgia, Colorado, Washington, Oregon, and Nevada. Much of the waiver activity during has focused on reinsurance programs. During the Trump administration, the most innovative waiver application was from Georgia, which sought to restructure and decentralize their individual market, moving away from the framework established by the ACA. While the Biden administration suspended Georgia's efforts, Democratic-led states have focused implementing waiver programs supporting and expanding on the ACA. This has included adopting public option insurance plans offered by private insurers and expanding eligibility for Qualified Health Plans for previously ineligible groups. Our analysis offers insights into contemporary health politics, policy durability, and the role of the administrative presidency.

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